Now to be fair, this season's flu situaton is taxing **our** system, as well (heck, I had a client die recently from it); the lesson here is that the clam that socialized medicine is somehow superior is, well, hokum.

Monday, January 29, 2018

FoIB and long-time LTCi Guru Randy Gallas offers his take on last week's post critical of a questionable (to me) Long Term Care insurance awareness effort:

"I agree that the State of Ohio needs to be more engaged in LTC awareness. I have contacted the Department of Insurance (DOI) on many occasions and their answer was always "we'd like to do more but we don't have the budget for sending out brochures or explaining Ohio's LTC Partnership program."

However they did in 2008 and these trifold brochures were available through the Ohio Department of Jobs and Family Services. A very informative planning brochure that was available to all licensed insurance agents. They are no longer printed.

By sourcing this out to the 3in4NeedMore has the appearance of a lead generation program that might be sold to a brokerage that may or may not even be in the State of Ohio. I would advise anyone who would like more information on LTC planning to contact their local insurance agent/agency.

As always, our 18 years of knowledge and claims experience is something that we enjoy passing along to anyone interested in long-term care planning."

Long time readers know that, for many years, I participated in a healing prayer group. One basic tenet of that effort was that the folks for whom we prayed had to know that we were doing so (and had given us their permission, as well). The reason for this was that we truly believed (and of course, this was not exclusive to our efforts or faith) that one's attitude plays a great role in how well (or even if) we heal.

Likewise, dressing up in a suit and tie (or nice dress and stockings) usually engenders a greater level of self-confidence. Perhaps Fernando had it right, after all.

Which brings us to this wonderful news item sent along to us by FoIB Holly R:

Turns out, there's been an on-going effort to upscale those ubiquitous (and generally less-than-flattering) hospital gowns patients are issued. While they do have obvious practical advantages, one can't help but think that they interfere, in at least some small measure, with the patient's own attitude and self-image, which in turn may hinder the healing process.

That may be changing, however:

"[H]ospitals are increasingly paying attention to patients’ experience, and that includes what they wear," says Bridget Duffy, whose company consults with providers on health care operations and the like.

Of course, only time will tell, but even the simplest of healthcare tools can play a pivotal role.

Friday, January 26, 2018

One, that the State of Ohio endorses the 3in4 campaign (more on that in a moment), and two, that the Partnership Program is new (it's far from it).

More pointedly, if the offer is simply for a pamphlet explaining how the Partnership Program works, why does it need my date of birth? Are they really going to personalize these brochures for every sucker person that replies?

Then there's the "Privacy Access Code." I 'get' that they'd like to track specifically who's replying, but why would they need this? If you're at the site, you're interested. Why isn't that good enough, without pinpointing individuals?

The site itself specifically says "The nonprofit 3in4 Association is dedicated to providing information to the public about senior issues, and does not underwrite or sell insurance."

Which is likely true, but notice that it doesn't say "and will not sell this information to agents who do."

Thursday, January 25, 2018

Kicking the can down the road is very bipartisan. Especially when the can is going to be used to fill full of our tax dollars. This has become a key feature of Obamacare. Nothing has been kicked further than the Excise Tax on employer sponsored plans - commonly referred to as the Cadillac Tax.

However, with unions and other business lobbyists turning up the pressure, Democrats in the House pushed a reconciliation bill that included an amendment to the Caddy Tax pushing the start date to 2018. (Note: it also increased the threshold substantially) Because of the shoddy way this bill was passed then addressed through a one party railroad, the end result was revenue on paper. Revenue that unions knew would never, ever be collected.

Under the reconciliation bill the new Caddy Tax revenues were to begin this year and generate $12 billion with another $20 billion next year. At least that is what was supposed to happen based on 2010 scoring. Instead we saw a bipartisan agreement in the 2015 spending bill that pushed the Caddy Tax another two years out with a new start date of 2020.

The latest installment came this past week with the government shutdown and subsequent passage of a short term spending bill. Once again we have bipartisan agreement of an additional two year delay pushing the Caddy Tax out to 2022.

The Caddy Tax has now been delayed almost ten years. One would think that such bipartisan support of postponing a tax that is despised by so many would be easy to repeal. Many groups like Fight The 40 have been working to do just that.

But here's the truth. Congress needs the Caddy Tax. They need it for the revenue on paper. When CBO scores in ten year windows it shows an accounting sleight of hand that many of us don't know. It shows as revenues - whether collected or not.

Having IOU's is how they trick us in to believing that they are good stewards of our tax dollars. Sad truth is they simply don't care about spending your money. They care about you voting to re-elect them. Which is why kicking the can down the road is the avenue of choice for those we elect in DC.

While this is indeed good news (because it means that at least some lawmakers "get it"), it's a far cry from a done deal:

First, as folks in medical-marijuana states have come to learn, Feds trump states. So, any such plans are going to be subject to the ObamaTax (at least for now). Which isn't necessarily an insurmountable impediment, but something to keep in mind.

Second, which carrier's going to put in the time, manpower and - critically - money to develop and price a plan available in only one state (and the 39th in terms of population, at that)? In general, insurance companies are reluctant "first adopters."

On the other hand, if this actually happens, it would represent the first effective argument I've seen for "sales across state lines."

Friday, January 19, 2018

DPC, of course, being Direct Primary Care, about which we've written extensively over the years (here, for example). My primary criticism of the model (and really the only substantive one from my perspective), is this:

I think this is a great idea, and I would suggest only that it doesn't really encompass the full value of such a change.

And what's that, Henry?

Well, in the Alternative Benefits field, we talk a lot about HSAs, but also HRAs (Health Reimbursement Arrangements) and FSAs (Flexible Spending Accounts). Seems to me that whatever magic necessary to make DPC fees HSA-eligible would, by definition, render them kosher for HRAs and FSAs, as well.

I suspect that there are a lot more FSAs (and, perhaps, HRAs) out there than HSAs, specifically in the group market (where employers' financial liability is much favorable to the former two).

Thursday, January 18, 2018

Last week, FoIB Jeff M and I were chatting and the subject of the (horrific and now deadly) California mudslides came up. We wondered if (and/or how) one would be covered if one's house (literally) went downhill.

Eventually, we turned to Co-blogger Bob, who's a regular participant in an agents' forum, and asked him to research there for this on our behalf.

We were not disappointed.

The two most helpful replies:

"Most HO policies exclude flood and earth movement. The NFIP forms define what "mudflow" is. DIC policies may cover mudslides and earth movement, but if it's in an area blighted by wildfire, availability and affordability could be an issue for a DIC policy."

And:

"Hello! Here's what I heard back from our underwriter @ Safeco... I am based at CA.

'No coverage for mudslide, only possibly covered under Flood coverage depending on the % of water in it (a mudflow). There is no coverage for hotel/food etc. under the home policy either if evacuated due to the mudslide. Mudslide is covered under EQ if a result of an earthquake.'"

Wednesday, January 17, 2018

It's been just a couple of weeks since we learned that Premier Health and United Healthcare had buried the proverbial hatchet; now we learn that the former is cutting loose what seems to have become quite the financial albatross:"Good Samaritan Hospital, the fourth-largest hospital in the Dayton region, will close."Premier Health appears to be streamlining its facility offerings, in line with its self-proclaimed "2020 strategic plan." The company says that Good Sam's services will still be available, just moved over to Miami Valley Hospital (about 5 miles, or 14 minutes, away). How that will work out is, of course, anyone's guess.Stay tuned...[Hat Tip: FoIB Debbie C]

According to Gallup, “After four years of Affordable Care Act implementation, the percentage of adults with no health care insurance has hit 12.2 percent”So is that an increase or a reduction? The linked article continues:“In the last quarter of 2016, the percentage of uninsured hit a record low of 10.9 percent. A year later, in the last quarter of 2017, the percentage of uninsured increased by 1.3 points—the largest single-year increase Gallup has seen since it began tracking the measure in 2008.”Based on US population of approximately 320 million, each 1-percentage point increase to the uninsured rate is about 3.2 million people. Do the math. The number of uninsured Americans increased by more than 4 million just at one enrollment - 2017! (For any progressives who may struggle with math, 3.2 x 1.3 = 4.1). Don't forget the premiums for 2017 were set B.T. - Before Trump. Also note that after 4 years of Obamacare, and despite the “mandate”, Americans age 26-34 have the highest uninsured rate = 20.1%. Can’t say that’s a surprise either.

He has since confessed to the crime, but is disputing some of the details that were obtained once the police were able to access his iPhone's health/activity data for the date of the crime. It seemed to confirm his guilt, but has raised some interesting questions (some of which we've seen echoed here: the Sam Bernadino tragedy comes to mind):

"Sean O’Brien, a researcher at Yale Privacy Lab [believes that it] would be much better... not to collect such surveillance data at all. Such data is best kept locally on devices whenever possible. If it is collected, those who handle it have a deep responsibility to defend the privacy of their users.”

It seems to me that there are (at least) two issues in play here:

First, as we've asked more than a few times before, who actually owns your data? It's not as clear-cut as one might think:

The information the device accumulates is stored in a proprietary format, inaccessible to Hugo (or anyone else, for that matter). The iPhone data is also, after a fashion: the owner must either give up the password or the authorities must (try to) use brute force to unlock it themselves. And of course here there are significant 4th Amendment issues at play here (not so much in Germany).

On the other hand, the data can be prove useful in other ways, (alleged) crime-wise:

Tuesday, January 16, 2018

Have you ever bought something that sounded sooooo good at the time but later regretted it? Perhaps that salesperson made it seem absolutely wonderful but neglected to tell you a few things. You know, stuff that, had you known at the time, might have led you to a different decision. But the salesperson kept talking and talking and talking.

Some people without brains do an awful lot of talking, don't they? - Wizard of Oz

One of InsureBlogs favorite curmudgeon's, Wendell Potter, penned an article for Medicare Resources that caught my eye. Recent discussions with fellow agents regarding how Medicare treats SNF care led me to an article titled "Why Mom Went Back to Traditional Medicare".

This is allegedly a true story and the names have not been changed to protect the innocent.

As it seems Wendell's real mom had a real Medicare Advantage plan. At age 91 Mrs. Potter is in relatively good health for someone her age. But according to her son she might not have been so lucky had she stayed on a Medicare Advantage plan. Like a good son, Wendell switched his mom from the Advantage plan to original Medicare when she was "critically ill".

Many Medicare Advantage enrollees do exactly what Mom did after a serious illness or injury, and the MA plans they “disenroll” from couldn’t be happier to see them go. When they go back to traditional Medicare, the MA plans are off the hook for covering expensive care.

According to Wendell, his reason for throwing Momma from the plan was this.

the head nurse took me aside and told me that another nurse – not at the facility but at Mom’s Medicare Advantage plan – had come to the conclusion that the skilled nursing was no longer “medically necessary.” This other nurse – a so-called “utilization management” nurse – had never laid eyes on my mother, much less treated her. But she was able to insert herself between my mother and her treating physician and, for all practical purposes, determine whether or not she would get the care her doctor said she needed.

Beyond being a dutiful son, Mr. Potter had RESEARCH to back up his decision.

Kaiser Health News quoted J. Michael McWilliams, the Harvard professor who led the research team, as surmising that “beneficiaries who developed serious ailments might leave the (MA) plans to get unfettered access to physicians and treatments through traditional Medicare.”

Unfettered access as opposed to managed care that is baked in to Advantage plans.

Claims submitted to original Medicare are still required to meet medical necessity standards, but there are no utilization monitors overseeing the ongoing claim. Claims are adjudicated AFTER THE FACT rather than ongoing when you have an Advantage plan.

That's not as bad as it sounds.

If the attending physician cannot prove medical necessity for the treatment under original Medicare the beneficiary is not responsible for the claim. An exception occurs if the patient signed an Advance Beneficiary Notification form PRIOR TO the procedure or treatment.

ABN applies to claims with original Medicare, but not Advantage plans.

So Wendell was able to use the system to get Momma off the managed care plan and into an un-managed plan with original Medicare.

But he neglected to mention one thing.

Disenrolling from the Advantage plan the way she apparently did negated any guaranteed right to purchase a Medicare supplement plan. The way his article is worded it appears this was a VOLUNTARY disenrollment, not one triggered by moving out of the service area or because her current plan was discontinued.

Perhaps his mother was healthy enough to qualify for a Medigap plan, or perhaps not. He does not elaborate on this point.

Disenrolling from an Advantage plan does allow you to go to original Medicare without answering health questions. But without the protection of a supplement plan the beneficiaries exposure on Part B is unlimited.

Or as I like to explain it, your 20% share of Part B expenses continues until you get well, run out of money or die.

Only one of those results is optimum.

While the saga of Mrs. Potter and the nursing home makes for an interesting read it can be a bit misleading to those who think disenrolling means you can automatically enroll in a Medigap plan.

Monday, January 15, 2018

With so many wonderful and useful site where one can get medical information and "advice", we find it odd that people would troll social media for health information. Yet, according to Dr. Audrey Nath (Kevin MD) if you want REALLY GOOD advice you go to Facebook.

Here is a sample query as paraphrased by Dr. Nath.

“Help! My baby has a fever, what do I do? I have a pediatrician, but I

clearly trust you guys more than that guy,” or, even better, “My child is ill and also having mental status changes that are rather concerning. Also, of equal importance, I need you to tell me exactly when the Mongolian spot on her back will disappear. Thanks in advance!”

Whatever happened to mom's advice about "never trust a stranger"?

One response to a question related to stomach distress.

“Grape juice is a remedy for any gastroenteritis, given that it changes the pH of stomach acid, and therefore, has some sort of antiviral effect.”

If grape juice is all that is needed take them to communion. Sure, some churches use real wine but even Apostle Paul said a little wine is good for digestion.

With sterling advice like this it makes you wonder why doc's charge so much for a consultation. And remember that Facebook does not charge a dime for membership.

While charging of co-pays would be a departure, it should come as no great surprise. In the first place, NHS financial problems have been public for quite a while. And, after all, NHS is just another insurance company - albeit a giant, national monopoly. Aside from the political control of its management and budgets, NHS behaves very much like private insurance companies around the world. Specifically, NHS has a large bureaucracy that determines what medical services are reimbursed, and under what terms. Also, NHS is financed by premiums that must must cover its costs - although NHS “premiums” are disguised as taxes.

And now - co-pays?

What next? Refusal to cover services of non-approved physicians and hospitals?

Friday, January 12, 2018

Obamacare imposes a "fee on insurance companies" for fully insured plans that is referred to as the HIT (Health Insurance Tax). Last year this tax was in a one year moratorium thanks to Congressional relief. But this year it is back in full effect.

The tax on health insurers is non-deductible, meaning for every $1.00 in taxes the insurer will need to take in $1.54 (assumes 35% corporate tax rate). For 2018, the amount this tax must generate is $14.3 billion - meaning insurers must generate $22 billion of additional premiums to pay for it. Insurers have to pay their portion based off of market share so the larger presence they have the greater the amount they have to charge. This also makes it a moving target from year to year.

The tax applies to all fully insured coverage including:

Individual On Exchange

Individual Off Exchange

Small Group Fully Insured - Both ACA and Pre ACA

Large Group Fully Insured - Both ACA and Pre ACA

Medicare Advantage

Medicare Part D

Medicaid Managed Care

To offer transparency, many insurers are breaking out these taxes on renewals for consumers to see. But, for most employer plans - where a large amount of this revenue is generated - this tax isn't transparent to employees.

Employers offer a total compensation package to employees. Wages and benefits are the biggest drivers of what makes up an employee's compensation. The HIT hurts employee wages and benefits while providing zero value to the business.

How bad does the HIT hurt employers? For my clients it's extremely painful. Reviewing my January 2018 renewals I found the average cost per employee is $356.50. That doesn't seem like much right?Until we do the math and show that this tax averages a cost of $0.17 per hour.

This puts an employer in a tough position. Do they give a $0.25 an hour raise but increase premium contributions by $0.17 an hour? Do they cut benefits by $0.17 an hour? Or, do they decline to expand, cut overtime, or reduce staff to pay the tax? These are tough decisions employers have to make that are all done behind the scenes.

Employees see these decisions to increase the amount deducted from their paychecks, higher deductibles, higher copays, more restrictive provider networks, and higher prescription costs as if the employer or the insurer is screwing them.

The reality is Obamacare's HIT is causing the problem. It's been screwing employees since 2014 and every year it will get worse.

The next time someone says Obamacare doesn't impact employer sponsored insurance remember the HIT. It's the sucker punch that keeps on coming.

Many people are confused about Medicare Advantage plans, especially those that do not charge a premium. (Free insurance. How can they do that?).

Excellent and logical question and one that comes up quite a bit. Most folks on Medicare are smart enough to know if someone offers you a product or service at no charge there must be strings attached.

But the $0 premium plans are a marketing gimmick by the carriers, not something baked into Medicare rules.

That is a discussion for another day.

Regarding doctor networks and Medicare Advantage plan consumers are once again faced with the question. If I like my doctor can I keep my doctor?

The answer is "yes".

Advantage plans do not forbid you from seeing certain doctors. You are free to use any doctor you wish . . . as long as you are willing to pay for that privilege.

From the KFF report (linked above):

As of 2017, 19 million of the 58 million people on Medicare (33%) are enrolled in a Medicare Advantage plan, yet little is known about their provider networks.

"Little is known about provider networks". I wonder how many of those 19M people really understand networks and what that means. In particular, what happens if you are in treatment at the end of the calendar year and your doctor(s), hospital(s) and clinic(s) are not in network the following year?

According to Kaiser, 78% of Advantage plans did not include all doctors who practiced in the service area. On average, less than half (46% per the survey) of physicians did not participate in Advantage plans. Some plans included 60% of physicians who practiced in a particular county while other plans had less than 10% of doctors participating.

The report included the following eye openers:

20% of plans had fewer than 5 thoracic surgeons

18% of plans had less than 5 neurosurgeons

16% of plans had fewer than 5 radiation oncologists

Remember, you are free to use any doctor you wish, including your own, but using someone that is not on the approved list can be harmful to your wallet.

And some doctors, including your regular one, may refuse to see you if you have an Advantage plan.

The size and composition of Medicare Advantage provider networks is likely to be particularly important to enrollees when they have an unforeseen medical event or serious illness. However, accessing the information may not be easy for users, and comparing networks could be especially challenging. Beneficiaries could unwittingly face significant costs if they accidentally go out-of-network. Differences across plans, including provider networks, pose challenges for Medicare beneficiaries in choosing among plans and in seeking care

If you opt for a Medicare Advantage plan, make sure you understand the rules and are willing to play by them. Otherwise you may be in for a rather costly surprise.

You can pick a plan with a broad network and fewer restrictions for using non-par providers, but you can expect to pay more.

Thursday, January 11, 2018

and all the networks did shrink. Doctors, doctors, everywhere but man does it really stink.

Access to health CARE was never a problem until Obamacare.

Most people, including those without health insurance, could AFFORD to see a doctor for routine care. But now many have little left over to pay a doctor after paying HUGE health insurance premiums.

But wait, there's more!

Even if you can afford the premiums AND have money left over to pay for your care, there is a new problem.

People who bought policies from Centene, a large for-profit health insurance company, filed a federal lawsuit on Thursday claiming the company does not provide adequate access to doctors in 15 states.

“Members have difficulty finding — and in many cases cannot find — medical providers,” who will accept patients covered under policies sold by Centene, according to the lawsuit filed in federal court in Washington State. - NY Times

You have government dictated and designed health insurance but no place to use it.

So Politico's Paul Demko reached out to me yesterday to ask about Health Care Sharing Ministries (HCSM), and specifically about whether or not I'd decided whether or not to market them. He was also interested in connecting with any (former?) clients who'd made the leap from Major Med to HCSM.

I was intrigued, and we agreed to speak this morning. In the meantime, I contacted several folks I knew who'd gone that route, especially hopeful that one in particular will respond.

Why her?

Well, because she was actually referred to me by a mutual friend at our synagogue. We had looked into ACA major med plans for her, but she ultimately chose a Ministry. Since these tend to be church-based I was intrigued, and Paul thought that would be really interesting to hear more about, as well.

Ultimately, we had a very nice conversation, and I told him that I'd let him know if I was able to connect with any of these folks so that I could send them his way (if they agreed that would be a good idea).

I don't know when (or even if) this article will be published, but will post a link to it here once it is.

Related: About 20 or so years ago I had a similar situation with a client. Small group health plan with $15,000 life and AD&D ("Accidental Death and Dismemberment);" the idea was that the death benefit doubled if one died from an accident (as opposed to illness). One of the employees, a young man (of course), decided to play chicken with a Ford Explorer (he was riding a motorcycle).

To my surprise, they actually care-flighted him to the hospital (to no avail, of course).

We submitted the death claim, which was approved for the underlying amount, but the AD&D portion were denied because the wording (more explicit than was the case here) said no "double indemnity" if alcohol was involved.

I had a few questions about that wording, too, but never had the opportunity to raise them.

Monday, January 08, 2018

I have unwell patients begging me not to send them into hospital. This is what ‘we’have become. The state of the NHS is shameful. My condolences - feel so upset for you and very angry on your behalf that this could have been avoided.

Wednesday, January 03, 2018

So in December, we began moving several small groups to Anthem (mostly from United Healthcare)(Heh). But we weren't alone, and they are severely backlogged.

How backlogged? Well, my rep told me that groups approved on December 21st are still not all keyed in. Which is a problem for groups approved late last month or even earlier this week.

Here's why that can be an issue: in the early morning hours of January 1st, one of my client's daughters suffered severe frostbite (long story). In fact, she had to spend time in the burn ward, and we're still not sure whether they'll be able to save her feet. As one can imagine, there's a heck of an ER and burn unit bill, and surgery is likely.

I've been on the phone with the hospital about this numerous times over the past few days; she'll be covered, but the billing situation is a mess (fortunately, this just happened so nothing's actually been billed yet).

She also mentioned that there seemed to be (at least) two factors involved here: first, of course, is the aforementioned exodus from UHC. But a close second is, interestingly, the implosion of the individual market, especially here in southwest Ohio: a lot of smaller employers who had been on the fence about installing a group plan took the plunge as a result of that implosion.

So, not a bad problem to be sure (hey, lots of new business means lots of new premium dollars), but a service mess for at least a while.[Hat Tip: FoIB Liz M]

Maryland sets an annual global budget
for each of its hospitals.The federal
government also participates in the regulations, by requiring that the
hospitals comply with the state-set budgets.I suppose the feds’ interest is that they finance Medicare and share in
the financing of Medicaid.But the global
budgets apply only to residents of Maryland.Hospital revenues from out-of-state patients – “medical migrants” - are
outside the global budgets and thus produce unregulated additional revenues for
the hospitals.

Hopkins’ former employee alleges
Hospital management pressured staff to migrate out-of-state patients into Hopkins
Hospital, taking beds that might otherwise have been available to Maryland residents, and
generating revenues that Maryland residents would not have generated.Hopkins has responded that “Our census shows
that the majority of our patients are from Maryland and that the number has
steadily increased over the past several years” - which is fine as far as it
goes, but does not directly or fully answer the issue.A judge will have to sort all this out.

2.Medical Tourism?This term describes a growing international trend among patients
seeking medical care outside their own country. It has been a recurring topic
at InsureBlog over the past few years - here is an old post from 2007; there
are many others.Medical migration is similar to medical
tourism because both have similar motivations and similar ends:the unbreakable linkage between money and
medical care, and access to medical care that may not be locally available. The
Johns Hopkins situation is not exactly medical tourism because it involves
movement between states in the same country, not between two different
countries. Yet it may be evidence that U.S. patients are
becoming more willing to travel for their medical care.And, of course, it’s also evidence of
hospitals’ continuing creative efforts to improve their revenues.

What’s that?Scotland is “exiling” certain patients to
other countries in the U.K. for medical treatment?

It’s complicated.It seems Scotland has allowed
at least 460 NHS specialist positions (plus an additional unspecified number of
nurse positions) to go unstaffed.As a
result, a growing number of Scottish patients face unexpected travel for
specialist or routine nursing care.NHS
Scotland is sending these patients to England, Wales, or Northern Ireland. NHS actually anticipated this as an infrequent
contingency, so there are funding and administrative means in place to handle referrals.But the recent, sharply increasing volume of
such referrals was not anticipated.Scotland has apparently been managing – or mismanaging - its understaffing
problem by “exiling” patients to obtain care outside their own country, rather
than filling the vacant specialist positions inside Scotland.

The available information is hard to interpret.For example, how does Scotland reimburse other
U.K. specialists?How does the sum of
those reimbursements compare to the sum of the salaries and other employment
costs for the 460 specialists the Scots would otherwise employ?I can’t help but suspect one of those numbers
is a fair bit larger than the other.

So why tie these three phenomena
together?Movement.

Specifically, the movement of a growing
number of patients willing - or obliged - to travel far from where they live,
in order to access medical care.Movement
of patients within the U.S. to access medical care has been a slow-growing thing for some years.But in other parts of the world, such patient
movement seems to be growing faster, and is more common across national
borders.And the worldwide phenomenon is
not exclusively physician- or patient-driven. Governments are facilitating and,
in some cases (i.e. Scotland), are requiring such travel.

Is patient movement likely to improve
care? Will it improve access? Balance patient loads? Result in better match of patient
needs with services across local, national, and international medical care
delivery systems?Or will it be not so
beneficial?Will these trends instead
end up exposing a world delivery system largely unprepared to meet the rising demand
for medical care? Is this the start of some classic B-movie, in which a flooding
river causes the dam to spring small leaks, as rising waters spill around and
over the dam, and no one is listening to the few townspeople who notice what is
happening?Time will tell.Meanwhile these phenomena are related, and do
bear watching.